Hiệu quả giảm đau sau mổ của phương pháp gây tê mặt phẳng cơ dựng sống (erector spinae plane block) cho phẫu thuật tim hở

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Tác giả: Thị Tú Oanh Đồng, Thị Hương Hoàng, Thị Nhung Lê, Hữu Tú Nguyễn, Thị Quỳnh Nguyễn, Văn Chung Nguyễn, Việt Đức Trần, Hoàng Phương Vũ

Ngôn ngữ: vie

Ký hiệu phân loại: 612.1 Blood and circulation

Thông tin xuất bản: Tạp chí nghiên cứu y học, 2021

Mô tả vật lý: 219-227

Bộ sưu tập: Metadata

ID: 489378

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Áp dụng gây tê mặt phẳng cơ dựng sống giúp giảm đau và không cần sử dụng opioid sau phẫu thuật tim hở. Mục tiêu của nghiên cứu là đánh giá khả năng giảm đau sau mổ của phương pháp gây tê mặt phẳng cơ dựng sống cho phẫu thuật tim hở. Thiết kế nghiên cứu can thiệp lâm sàng không đối chứng được thực hiện từ tháng 6/2020 đến tháng 6/2021 tại Bệnh viện Đại học Y Hà Nội. 54 bệnh nhân tuổi từ 18 đến 80, có chỉ định mổ tim hở theo kế hoạch, được đặt catheter ESPB hai bên ngay trước khi khởi mê, liều ropivacain tính theo cân nặng bệnh nhân, phối hợp thêm paracetamol truyền tĩnh mạch sau mổ. Điểm visual analogue scale, huyết áp trung bình khi nghỉ và khi vận động được đánh giá tại các thời điểm ngay sau rút nội khí quản và sau rút là 6, 12, 18, 24, 36, 48 giờ
đánh giá khí máu động mạch mỗi 24 và 48 giờ. Kết quả cho thấy điểm VAS trung bình khi nghỉ và lt
3 và khi vận động ≤ 4. Có 7,4% bệnh nhân phải chuẩn độ morphin
3,7% bệnh nhân phải phối hợp PCA morphin. ESPB (Erector spinae plane block) không làm tụt huyết áp và các chỉ số khí máu động mạch trong giới hạn bình thường ở các thời điểm nghiên cứu
không có biến chứng sau phẫu thuật. Gây tê mặt phẳng cơ dựng sống là phương pháp an toàn hiệu quả trong giảm đau sau phẫu thuật tim hở.Open cardiac surgeries may cause severe post operative pain. The erector spinae plane block (ESPB) would have adequate analgesia effect and have decreased postoperative opioid consumption. The objective of the study was to evaluate the effect of ESPB for open cardiac surgery. A clinical trial study from June 2020 to June 2021 was carried out at Hanoi Medical University Hospital. 54 elective open cardiac patients from 18 to 80 years old received continuous bilateral ESPB before induction of anesthesia. The ropivacain dose was counted based on patient's weight with combination of paracetamol i.v postoperation. The visual analogue scale (VAS), mean blood pressure were recorded at rest and at 0, 6, 12, 18, 24, 36, 48 hours postextubation, the arterial blood gas was recorded 24 and 48 hours postextubation. Result shown that the mean VAS less than 3 at rest
less or equal to 4 at the time of movement. 7.4% of patients need morphine bolus and 3.7% one need morphine PCA. ESPB did not affect the mean blood pressure and the results of ABG were normal. There was no complication such as bleeding, pain, infection at ESPB site, postoperative nausea/vomitting or local anesthetic systemic toxicity. We suggest that ESPB is a safe, effective analgestic method for open cardiac surgery.

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